1. Bowel Obstruction: Infants and Children
Age specific:
Adhesions, Malrotation, intusception, meckel’s, appendicitis (“febrile obstruction”)
Hx + Physical much closer to adults

3. Presentation Four cardinal signs of intestinal obstruction in neonate
Antenatal polyhydramnios
Bilious vomiting
Delayed passage of meconium (> 24 hrs)
Gastric residual > 30 cc
Cardinal sing in adult
Vomiting
Abdominal pain
Abdominal distension
Obstipation/ constipation

4. Perioperative Management
Fundamental rule: previous losses /maintenance/ongoing needs
Urine output best measure of adequate resuscitation
?Need for central monitoring if problematic
Recall distribution of various IV solution
Bolus: as per PALS (20 cc/kg)
Titrate to heart rate, urine output BP
↑ Maintained 25% for each quadrant of abdomen involved
Antibiotics if any viscus opened, cardiac issues, immunosuppresed (newborn)
Steroids: if on previously/deficiency (stress dose physiology)
Nasogastric tube (Decompression)
Keep patient warm

5. Be Aware of Child with Bilious (Green) Vomiting

6. Malrotation
10th Week of Development rapid growth of intestine which returns to abdominal cavity with rotation
Problems can occur at any of the 3 stages
Duodenal rotation
Elongation and fixation of the mesentery
Rotation of the colon

8. Tracheo-esophageal fistula
Presentation
Maternal polyhydramnios on U/S
Drooling, choking, coughing, cyanosis with feeding  tracheomalacia
No passage of NG tube
VACTERL
(Vertebral, anal, cardiac, tracheal, esophageal, renal, limb)
Work-up
Complete physical exam
CXR, AXR – vertebral / rib anomalies
Echocardiogram – aortic arch L vs. R to plan incision
Renal U/S
CT head in selected patients
Pneumonitis prevention and treatment
Parenteral antibiotics – gentamicin, ampicillin
Sump suction catheter (Replogle)
Treatment  surgical repair

9. Meckel’s Diverticulum's
True diverticulum's
Result from persistence vitelline duct and the omphalomesenteric duct.
Incidence 2%, Most of these people remain asymptomatic throughout life.
Role of 2.
Complication: hemorrhage, acute diverticulitis, perforation, and small bowel obstruction or intussusception

10. Intussusception

11. Duodenal Atresia/ Annular Pancreas
Primary problem is one of recanalization of solid duodenum.
Obstruction typically at level of common bile duct and pancreas
Associated anomalies common: almost 50%
Down syndrome 29%
malrotation 19%
congenital heart disease 17%
TEF 7%
Others (renal, respiratory, imperforate anus - roughly 10%)

12. Jejunal & Ileal Atresia
Pathology related to late second trimester vascular accident (Barnard)
Associated anomalies rare
Classification system

13. Imperforated Anus

14. Hirschsprung’s

16. Meconium Ileus

17. NEC

18. Abdominal Wall Defect
Omphalocele
Gastroschisis

19. Wilms tumor asymptomatic abdominal mass Well baby
rapid abdominal enlargement ( pain, fever, and gross hematuria). 2 to hemorrhage
Treatment is surgical resection

20. Neuroblastoma
Neuroblastoma cells are derived from the primitive neural crest
It was found that patients with an increased number of copies of the N-myc gene had a much worse prognosis
Site: adrenal, retroperitoneum, mediastinum & neck.
Treatment: surgery +/-chemotherapy

21. Duplication Cyst

22. Question?